1. Field of The Invention
Applicant's invention relates to surgical instruments and more particularly to methods and techniques of suturing within a body cavity such as the abdominal cavity of a human or an animal.
2. Background Information
Many surgical operations are being performed endoscopically and as technology advances new applications are being developed. The primary advantage to the patient of laparoscopic surgery is that the post operative recovery period is dramatically shortened thereby reducing the period of hospitalization. In addition, patients return to work much sooner than after surgery with large incisions.
Some of the technical problems encountered by those practicing laparoscopic surgery includes the need to perform delicate three dimensional procedures while looking at a two dimensional video screen since laparoscopy is performed with the operator looking solely at a two-dimensional video screen for guidance. This makes it difficult to grasp and manipulate suture needles because of the complete loss of depth perception.
Applying the existing art requires that, once a suture needle has been grasped using presently available instruments, the needle is inserted into the tissues by way of rotation of the instrument which, in turn, is effected only through a rotational movement of the user's wrist. This is often difficult and complicated because the operator typically has only a very limited range of movement caused by the constraining effect of the substantially immobile abdominal wall coupled with the location and position of the laparoscopic cannula through which the needle holding instrument must pass. These problems, coupled with the difficulties associated with the present generation of suture needle holders, make suture placement time consuming. This, in turn, translates into more expensive and at least slightly more risky procedures.
Most current endoscopic needle holders are modifications of conventional needle holders where the needle is simply grasped by hinged jaws. A characteristic necessarily common to most endoscopic instruments--being both long and slender--works counter to providing an effective needle handling capacity when applying the techniques of the prior art. The hinged jaws which are common to existing needle grasping mechanisms are necessarily small. To the extent that mere scissor-like mechanisms are used to apply the compressive force to the hinged jaws, the length of the instrument combined with its low mass prevents generating aim effective compressive force on the grasped portion of the needle. This results in a tendency of the needle to rotate in the jaws as the surgeon attempts to place a suture.
A further difficulty with current needle holders is that once the needle is secured in the needle holder it is often difficult to advance the needle through the tissues in the desired direction because of the limitations caused by the location of the endoscopic cannula and the technical difficulty in rotation of the operator's wrist. Occasionally, the surgeon has to pass the needle more than once in order to obtain the correct placement of the needle.
The present invention provides an instrument which allows a suture needle to be rotated between desired positions, in the process passing through a definite and specific arc lying in a stationary plane. The needle's movement is effected, not through rotation of the instrument through rotation of the user's wrist, but rather by simple opposition of the thumb and the second and third fingers as applied to the actuating members of Applicant's new instrument. Accordingly, Applicant's invention allows for accurate and less difficult placement of sutures, and the problems and difficulties associated with wrist rotation as required when practicing the prior art are thereby wholly eliminated.
Applicant's instruments also effect a secure grasp on a suture needle notwithstanding the instrument's size and shape being ideal for endoscopic surgery.
Prior issued patents which are known to Applicant and which relate to needle holders which are used during surgical operations are revealed in the discussion to follow.
The problem of adequately securing a needle has been partially addressed through an instrument manufactured by COOK OBGYN and disclosed in U.S. Pat. No. 5,015,250. The COOK OBGYN instrument involves a needle lying in a groove in a hollow channel. The needle is secured by a spring loaded rod which immobilizes the needle in the channel. Nevertheless, the disadvantages of this instrument are that (1) the spring is very strong and requires great force to grasp and release the needle, and (2) the handle portion is not rotatable relative to the remainder of the instrument such that placement of the needle in the tissues requires a rotational movement of the wrist and arm. This makes precise placement of the needle very difficult.
U.S. Pat. No. 4,898,157 issued to Messroghli et al is a needle holder not specifically designed for endoscopic use. Pressure on the handles is converted into a longitudinally directed force which is converted into pressure on a movable jaw to grasp a surgical needle. Once again, it is believed that even if modified, the force applied to the needle would be inadequate to truly secure the needle under many endoscopic surgery conditions.
A needle taught by Yasukata Eguchi et al (U.S. Pat. No. 4,527,564) has a rectangular proximal end which allows for rigid grasping by a needle holder. The needle is not, however, suitable for endoscopic surgery.
U.S. Pat. No. 4,760,848 issued to Hasson addresses the difficulties associated with wrist movement in endoscopic surgery. Hasson's invention uses conventional needle holding jaws that self lock. Rotation of the needle during its insertion is effected by rotation of the instrument with the thumb and fingers. The grasping mechanism is suitable for very small needles used in microsurgery, but does not grasp the needle sufficiently securely for laparoscopic surgery.
U.S. Pat. No. 4,621,640 issued to Mulhollan discloses a mechanical needle carrier which holds a surgical needle for use during endoscopic surgery. This is a small needle which is contained within the sheath of the, instrument and is advanced through tissues by rotation of a knurled rod. The size of the needle is limited by the diameter of the shaft and is too small to be applicable to abdominal or thoracic endoscopic surgery. A similar problem plagues the suturing instrument described in U.S. Pat. No. 4,557,265.
U.S. Pat. No. 4,923,461 issued to Caspari discloses a method of suturing for arthroscopic surgery that incorporates a hollow needle and a mechanism whereby suture may be fed through the hollow needle.
U.S. Pat. Nos. 4,484,580, 4,417,532 and 4,406,237 issued respectively to Nomoto et al, Eguchi Yasukata, and Yasukata Eguchi et al, as well as earlier referenced U.S. Pat. No. 4,527,564, all teach needles each having a distal eye through which suture thread passes. These needles are each rigidly attached to a shaft which allows precise placement, but are locked in a fixed position and cannot be retracted to allow passage through an endoscope. Also, these needles are necessarily of a size which preclude their exit through an endoscope, even if not locked in place. Even if these needles were to be reduced in size sufficiently to pass through an endoscope, they would be too small for most abdominal or thoracic applications.
U.S. Pat. No. 4,935,027 issued to Yoon teaches a suturing instrument which places suture material through tissues endoscopically by grasping tissues between two hollow jaws and passing suture from one to the other.
U.S. Pat. No. 4,164,225 issued to Johnson et al also grasps tissue between two jaws. Activation of a plunger allows a suture bearing needle to pass from one jaw to the other and thereby pass suture material through the tissues. A similar achievement is performed by U.S. Pat. No. 3,946,740 issued to Bassett.
U.S. Pat. No. 4,793,379 issued to Weinrib describes a microsurgical needle holder which has a hook on one jaw to assist in grasping the needle securely.
U.S. Pat. No. 3,842,840 issued to Schweizer discloses a suture clamp in which a needle is driven from one jaw to the other carrying a length of suture through the grasped tissues. Because of the scissor-like action of the Jaws this instrument is not suitable for endoscopic surgery.
Mulhollan in U.S. Pat. No. 4,597,390 describes a novel endoscopic needle holder in which the needle is firmly held by slots in two hollow members. The needle is inserted into tissues by rotation of the shaft of the instrument.
U.S. Pat. No. 3,871,379 issued to Clarke describes several endoscopic instruments, one of which is an articulated needle with a distal eye. This instrument allows a curved needle to be inserted through an endoscopic cannula. Abduction of the handles causes the needle to be displaced laterally, but does not cause it to travel through a specific arc.